BVA9501828 DOCKET NO. 91-41 758 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Cleveland, Ohio THE ISSUES 1. Entitlement to service connection for residuals of a fracture of the right fifth finger. 2. Whether new and material evidence has been submitted to reopen a claim of entitlement to service connection for chronic gastrointestinal disability. 3, Entitlement to an increased (compensable) evaluation for residuals of a shell fragment wound of the right arm. REPRESENTATION Appellant represented by: AMVETS ATTORNEY FOR THE BOARD Nadine W. Benjamin, Counsel INTRODUCTION The veteran served on active duty from August 1943 to January 1946. This matter comes before the Board of Veterans' Appeals (Board) on appeal from December 1989 and February 1991 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Cleveland, Ohio. In December 1991, the Board remanded the case to the RO for additional development. In October 1993, the Board again remanded the case to the RO for additional development. This decision will address the issue of entitlement to service connection for residuals of a fracture of the right fifth finger. The issues of whether new and material evidence has been submitted to reopen a claim of entitlement to service connection for chronic gastrointestinal disability and entitlement to an increased (compensable) evaluation for residuals of a shell fragment wound of the right arm will be addressed in the remand that follows the decision. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that service connection is warranted for residuals of a fracture of the right fifth finger, which he argues were incurred in service. Specifically, he asserts that he injured his right fifth finger during the use of a machine gun. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the evidence is at least in equipoise and thus, with resolution of reasonable doubt in the veteran's favor supports the veteran's claim of entitlement to service connection for residuals of a fracture of the right fifth finger. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the RO. 2. The veteran has an identifiable right fifth finger disability which is the residual of an injury in service. CONCLUSION OF LAW Residuals of a fracture of the right fifth finger were incurred in service. 38 U.S.C.A. § § 1110, 5107 (West 1991). REASONS AND BASES FOR FINDINGS AND CONCLUSION The veteran has submitted a well grounded claim within the meaning of 38 U.S.C.A. § 5107(a) (West 1991). That is, he has submitted a claim which is plausible or capable of substantiation. The Board is satisfied that all relevant facts have been properly developed and that no further assistance to the veteran is required to comply with the duty to assist the veteran as mandated by 38 U.S.C.A. § 5107 (West 1991). Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. § 1110 (West 1991). The veteran's August 1943 service entrance examination report shows no musculoskeletal defects. His service medical records show no treatment for an injury to the right fifth finger. However, his January 1946 separation examination report notes that the veteran had no extension power of the distal joint of the fifth finger of the right hand. The veteran was examined by the VA in December 1990, and he reported that he had broken his right fifth finger on a machine gun and he complained of occasional tenderness. On examination, flexion was noted to be normal and a mild extension deformity of minus 5 degrees was noted. Residual injury of the right hand was diagnosed. He was again examined by the VA in February 1992, and it was noted that the veteran probably had a rupture of the extensor tendon at the base of the distal phalanx that sometimes occurred with a small fracture, called an avulsion fracture. The veteran could not extend the distal interphalangeal joint beyond 15 degrees. This was found to be a mallet deformity. The diagnosis was mallet deformity of the fifth finger on the right. The Board notes that although there is no record of treatment for an injury to the veteran's right fifth finger, his separation examination report showed that he had no extension power of the distal joint of the fifth finger of the right hand. No such disability was noted on entrance into service. The veteran has reported that he sustained an injury to the fifth right finger on a machine gun, and the Board notes that his discharge report notes his military occupation to be machine gunner. Recent VA examinations have documented a right fifth finger disability. The Board finds that with resolution of reasonable doubt in the veteran's favor, the evidence supports a finding that the veteran sustained an injury to the right fifth finger in service and that he now has disability which is identified as a residual of that injury. Accordingly, service connection is warranted. ORDER Service connection for residuals of a fracture of the right fifth finger is granted. REMAND The Board notes that the veteran was last examined by VA in February 1992, and that it has recently been determined that he is residing in a nursing home. Although the case was previously remanded by the Board, it must be noted that the United States Court of Veterans Appeals in a number of cases has determined that where the record before the Board is inadequate, a remand is mandatory rather than permissive. Sanders v. Derwinski, 1 Vet.App. 88 (1990); Littke v. Derwinski, 1 Vet.App. 90 (1990). The Board has determined on review that additional development is necessary. In view of the foregoing, the case is hereby REMANDED to the RO for the following development: 1. The RO should contact the veteran and request that he identify the names, addresses and approximate dates of treatment for all VA and non-VA health care providers who have treated him for gastrointestinal disability at any time since service and for residuals of a shell fragment wound of the right arm in recent years. With any necessary authorization from the veteran, the RO should attempt to obtain copies of pertinent treatment records identified by the veteran which are not currently of record. Records from the nursing home at 5440 Charlesgate Road, Hubert Heights, Ohio, should be obtained and associated with the claims folder. 2. Thereafter, the veteran should be afforded a VA examination by a board certified orthopedist, if available, to evaluate the current manifestations of his service-connected residuals of a shell fragment wound of the right arm. The examiner should also be requested to review the material in the claims file and any indicated studies, including X-rays, should be performed. 3. Thereafter, the veteran should be afforded a VA examination by a board certified gastroenterologist, if available, to determine the nature and extent of the any current gastrointestinal disability. All indicated studies should be performed. The examiner should be requested to review the claims folder prior to the examination, and provide an opinion regarding the etiology of any gastrointestinal disability found to be present, to include whether it is at least as likely as not that any current gastrointestinal disability is related to the gastritis which was treated during service. A complete rationale should be given for all opinions and conclusions expressed. 4. Then, the RO should undertake any other indicated development, and readjudicate the remaining issues on appeal. If the benefits sought on appeal are not granted to the satisfaction of the veteran, or if a timely Notice of Disagreement is received as to any other issue, a Supplemental Statement of the Case should be issued, and the veteran and his representative should be provided an opportunity to respond. Thereafter, the case should be returned to the Board for further consideration, if otherwise in order. By this remand, the Board intimates no opinion as to any final outcome warranted. No action is required of the veteran until he is otherwise notified by the RO. ROBERT E. SULLIVAN Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. Under 38 U.S.C.A. § 7252 (West 1991), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Veterans Appeals. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (1993).